Is the twelve step language of “character defects” stigmatizing? Excessive moralism is a genuine danger, but there is an important ethical dimension to recovery from addiction.
Recently, I read a cri du coeur by someone who felt betrayed by twelve step programs such as Alcoholics Anonymous (AA). Alongside other accusations, the author claimed that AA blamed people with addiction for their illness, thus contributing to stigmatization. His proof? The importance that the twelve steps give to to character or personality defects. As part of performing a personal inventory for step 4, twelve steppers identify personality defects that contributed to selfish and destructive behaviour during their period of active use. In steps 6 and 7, they become ready to have G-d remove their defects of character and then humbly ask their higher power to relieve them of these shortcomings. For many outsiders, this all sounds like arcane gibberish. What does asking some nebulous force of the universe to remove our personal failings have to do with treating a disease? If moral perfection is a prerequisite for recovery, we are all doomed. A few days later, I saw a more subtle version of this argument by someone I follow on Twitter. He maintained, correctly, that some people suffering from addictions are self-medicating for serious mental illness. It is absurd and cruel, he concluded, to attribute their alcohol and drug use to character defects such as self-centeredness.
The twelve steps are a framework and way of living that has allowed me to stop drug use and radically transform my life for the better. They have worked for millions of people struggling with addiction when therapy, self-help, and other forms of treatment failed. However, they are neither the only path to fulfilling, sustained sobriety (a word with many possible meanings), nor do they work for every person. Twelve step programs like Alcoholics Anonymous, Narcotics Anonymous, and Al-Anon are human institutions which contain within them—in varying degrees—all of the flaws of our all-too-human culture. Bill Wilson (one of AA’s co-founders) asserted unequivocally that the roads to recovery are many. Alcoholics Anonymous (often, unfortunately in my opinion, called the “Big Book”) states that if a person suffering from alcoholism wishes to pursue other avenues of help, they should be encouraged. Its words: “we have no monopoly.” Twelve step programs arrested my addiction and placed me in a better place to deal with many issues, but step work is not treatment for some of my other serious problems such as trauma and bipolar disorder. To address these issues, I need professional medical and therapeutic help (something clearly supported in AA literature). Some people have had genuinely horrible experiences because they land in a toxic group or self-described “old timers” give them unethical medical advise about questions like mental illness or pain management. In other cases, people are sometimes mismatched when they were pressured into programs by outside institutions such as courts. When I hear about these experiences or read about them online, I believe them. Then I ask myself how I can cultivate greater humility so that I am not part of causing harm.
In the 1960s, Bill Wilson responded to a widely publicized critique of AA by reemphasizing that the program would never be without limitations and faults. The fellowship, he advised, should cultivate openness and gratitude towards its well-intentioned critics. As a member of two twelve step organizations, I strive to emulate this attitude. Whenever I encounter a polemic against AA or NA, I ask how it might help me work my programs better. Even when the author completely misrepresents twelve step recovery (according to my flawless interpretation, of course!), I try to grasp the origins of the confusion. Can this misunderstanding clarify the way I live and communicate the message? In the case of the arguments regarding steps 6 and 7, it does not take a great leap of the imagination to discern their source. A close reading of the Twelve Steps and Twelve Traditions suggests that AA members have questioned the language of “character defects” since the early days. That was certainly true of my first sponsor. He preferred the idea of “coping mechanisms” that had stopped functioning and gradually became poisonous. In some fellowships (especially Al-Anon), it is stressed that many character defects are actually positive traits, for example loyalty, that are overdeveloped or applied in the wrong context. This approach undercuts ethical absolutism. Given the number of people who come into recovery crippled by guilt, shame, and/or devastated self-esteem, there is a real danger that the language of morality can reinforce a viscous cycle of self-flagellation. And, as the Twelve and Twelve observes, excessive guilt is an obstacle to the kind of honest personal assessment necessary to pursue twelve step work. (Full discloser: my sponsor and therapist are both working to get me to internalize that self-punishment is always harmful. I’m a work in progress.)
How do I understand the question of character defects and their removal? Today, a rich literature exists interpreting the steps in relationship to almost every conceivable philosophical framework: Buddhism, Yoga, secular humanism, Christianity, psychoanalysis, feminism, and many more (Marxism and the twelve steps? I haven’t seen it, but I bet it’s out there…). There are multiple ways to understand each of the steps and how they relate to each other. I claim neither authority nor novelty. What worked for me yesterday, may not work for you—nor for me tomorrow. That being said, I approach steps 6 and 7 in an entirely mundane, practical, and common sense fashion. They are the least mysterious part of my program. Rather than character defects, I find another term in the Twelve and Twelve useful: “maladjustments.”
My maladjustments are emotional distortions that twist or undermine my ability to interact with reality. They include my “character defects” in the classic sense, i.e. the seven deadly sins of lust, pride, sloth, and the rest. According to my understanding, they also include my ongoing mental health issues such as trauma, anxiety, and depression. They also encompass symptoms of existential or spiritual malaise: cynicism, despair, and a profound sense of meaninglessness. I don’t believe that maladjustments caused my alcoholism and drug addiction. Addiction caused my addiction: I have an irrational urge to consume alcohol and drugs that frequently overrides my ability to stop. However, I also drank to smother depression and anxiety as well as loneliness and emptiness. So it makes sense that finding ways to alleviate these experiences will help me not pick up. To put it another way, my addiction might be a neurobiological disease, but my alcohol and drug use were behaviours rooted in how I lived on a daily basis. I sometimes grabbed a drink to self-medicate for trauma, sometimes to allow myself to access emotions, sometimes to feel comfortable in social situations. In my first months in the program, I had to alter how I responded to stress, depression, and anxiety to maintain my sobriety. Eventually, I began to work on transforming these latent states.
I also want to stress this: my addiction didn’t cause my emotional maladjustments. I was self-centred, arrogant, and dishonest before its onset (to name a few of my charming qualities!). That being said, fifteen years of active use corroded and warped my ethical core. I hear addicts like me say it all the time. By the time my illness reached its worse, I was doing things that I would have never imagined possible: stealing from friends, trading sex for drugs, endangering other people’s safety and wellbeing in a variety of ways. I became habituated to lying and manipulating in every area and every aspect of my life. Hypocrisy and scamming the world became ingrained dispositions. Getting sober required learning not to turn to drugs for relief. Staying sober required moral rearmament. I don’t know of any other language to express my truth.
In my experience, the hardest part of steps 6 and 7 was not recognizing my emotional distortions. It did take time to see the full power of their hold on my interiority, but I had been lacerating myself or semi-consciously fleeing them for aeons. Step work gave me new names and ways of understanding my defects, but at a gut level I knew that many of them were there. No, the great obstacle was the cultivation of readiness to live without them. This resistance might sound utterly bizarre. Who doesn’t want to be a better person? The classic example is self-righteousness. In the abstract, eliminating self-righteousness might sound glorious, but am I actually willing to relinquish that subtle pulse of superiority I feel when outraged over an injustice? Am I willing to forgo the sense of security that I derive when I am (so obviously) right in a Twitter argument? Personally, I have a long way to go. Another powerful example of this resistance, for me, concerns my depression and trauma. I spent almost two decades ignoring or denying the truth that I suffer from serious metal illness. After my first year of sobriety, it became clear that I needed to address these issues if I was going to stop inflicting harm on myself and the world around me. Not seeking treatment was definitely a form of self-harm. Willingness to live without these distortions—which provided secure, recognizable zones for me—entailed getting to the point that I was able to ask for help and do the painstaking therapeutic work of confronting my past. It took a year-and-a-half to reach this point. I needed help to achieve willingness.
The final stage of my steps 6 and 7 was the recognition that I couldn’t transform my maladjustments on my own. Despite years of effort, I was unable to will my addiction away. I am equally unable to transform my emotional distortions through the force of thought. I need outside assistance. What this help looks like differs with the kind of maladjustment. For my anxiety, I have found therapy and yoga useful. For my depression, I take Wellbutrin. For my arrogance and insecurity, I cultivate humility through service in and out of the rooms. Most importantly, I try to surround myself with people who possess the qualities that I want to develop—honesty, humility, patience, tolerance, and kindness—and I emulate them by doing the things that they do. And that’s it. Steps 6 and 7 require that I become aware of how my emotional life distorts my relationship with reality, develop an honest willingness to change that relationship, and find appropriate outside resources to nurture healthy ways of living. If one asks, I can tell you how G-d was involved in my process, but a thousand other names for exterior assistance would have served the same purpose for my recovery.
If the steps can be rephrased in practical, non-moralizing terms that eliminate reference to G-d, why not just do so? After all it’s the twenty-first century. Isn’t it time to remove morality from treatment for what is, after all, a medical illness? Let me start by saying that I find these questions reasonable. They have analogues within different twelve step traditions. NA literature, reflecting the intellectual mood of the 1960s and 70s, focusses more on psychodynamic processes. I have read that Gamblers Anonymous is fairly secular in its interpretation of the steps. This approach is clearly more effective for some people than the religiously infused language of AA. I often find myself translating the steps into more pragmatic terms to work my program. At the same time, there is a central moral component to my recovery not captured by psychological or biomedical understandings of this illness. Addiction profoundly disrupted my relationship with the world and recovery requires rebuilding this relationship on sustainable terms. And how I exist in the world contains an irreducible moral dimension. Or, if this word makes you cringe—it once made me cringe—please substitute ethical, political, or spiritual for moral. We might be able understand the individual mechanisms of addiction through abstract neurobiological models. But recovery is a concrete process infused with meanings and values grounded in our relationship with family, society, and being-in-the universe.
In short, addiction might be morally neutral, but recovery is not. I know that this statement might raise hackles. The current anti-stigma messaging emphasizes that addiction is not a choice, it’s a disease. On every front, we are trying to make it clear that addiction is not a personal failing. Whether this framing will prove effective in reducing stigma is an open question. Many experts worry that the emphasis on the “brain disease” model will essentialize addiction while erasing its social dimensions. I want to make a different argument. Addiction is characterized by a particular dynamic. In the spiral of active use, we inflict profound damage on ourselves and, blinded by our own pain, don’t truly grasp how this violence radiates, seeping into the world around us. In recovery, we learn to stop self-harm and this fact—on its own and outside any particular definition of sobriety—begins to transform our relationship with the individuals and communities that fill our lives. This process is always embedded in familial, cultural, or social contexts. We can employ many different types of language to describe this restoration and repair of self in relationship to others. During the actual process of recovery, an individual necessarily makes use of words and concepts charged with the power to give meaning to their own suffering and the consequences of their behaviour. For a significant minority, especially among the college educated elite, a secular vocabulary that emphasizes the disease’s medical and psychodynamic dimensions will do the trick. In our society, the majority of people understand their relationship to self and community in both moral and religious terms. They will therefore draw on their meaning-making traditions to articulate the work of individual and collective healing.
Finally, the moral dimension of recovery should lead us to cultivate a creative flexibility with regards to language. We need to listen carefully to the labor that ethical and religious terms are performing for the people that utilize them. This type of hearing is a genuine art. In the context of the overdose crisis, there is an important and urgent campaign to remove stigmatizing language from press, clinical settings, and public health communication. Outside these arenas, however, most people discuss addiction with a motley array of terms and concepts drawn from recovery communities, (often antiquated) scientific research, psychology, self-help, and faith traditions. The current vocabulary in one milieu is often unknown or long-dated in another. With some regularity, I hear people deploy terms in twelve steps contexts that they find liberating and powerful for their recovery. In academic or advocacy spaces, I encounter researchers and clinicians who interpret the same words in a completely different fashion and roundly critique them as being harmful or blaming. In my experience, most clinicians and twelve steppers are highly sensitive to this craggy landscape. Language policing in recovery circles is a new and (thankfully) relatively rare phenomenon. My argument is that this linguistic anarchy reflects, among other dynamics, an essential duality of addiction. Yes, addiction is a medical illness, but as a “disease of the free will” (Nora Volkow’s phrase) it manifests through actions and in terms of social relationships that are permeated with values, including our relationship with ourselves. Confronting the full reality of addiction, it makes perfect sense that many people in recovery would employ highly-charged, moral terms in taking responsibility for the management of their disease. Failure to find this path is not only life-threatening, it endangers the well-being of the people in our lives. It also makes sense that affected communities would sometimes turn to the language of morality or religion in their efforts to articulate and make visible their pain. The devastation produced by addiction is all too real. Moral judgement can be a reflection of stigma. But it’s not necessarily so.
For my part, I hurt many people while using, some terribly. These actions were no less wrong than if I had been sober. It’s what I must do to change these behaviours—and prevent them from recurring in the future—that distinguishes me from people without this illness, not the moral status of the acts themselves.